Healthcare Provider Details

I. General information

NPI: 1891439592
Provider Name (Legal Business Name): AMBERLYN JUNE PLATH FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 W 14TH ST
TEMPE AZ
85281-6908
US

IV. Provider business mailing address

PO BOX 96770
PHOENIX AZ
85072-6770
US

V. Phone/Fax

Practice location:
  • Phone: 623-267-8467
  • Fax: 623-254-6954
Mailing address:
  • Phone: 425-243-3719
  • Fax: 844-325-0677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704235250
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number286811
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: